INNOVATOR OF THE YEAR
Official 2011
Entry Form

Nominations are due September 9, 2011
Please completely fill out this entry form and submit it here electronically.

You may nominate a professional within your company or at another company.

If you have problems submitting this form electronically,
contact Tammie Gonzalez at (208) 387-4244 or tlgonzalez@stoel.com.

 

NOMINATION CATEGORY
(select one)

Innovator of the Year
Innovative Company of the Year
Commercialized Innovation of the Year
Early-Stage Innovation of the Year
NOMINATOR INFORMATION
As the nominator, please provide your name and contact information.

Name
Title
Organization
State
Phone
Email

PREVIOUS NOMINEES

If you previously submitted a nomination that was not named a winner, and you would like the same innovation to be reconsidered for the 2011 awards, indicate below.

I would like the Selection Committee to review a nomination form submitted in previous years.

Name of nominee

Please provide us with an update on the nominee. For example, information on his/her most recent accomplishments

By clicking above, the Selection Committee will review the nomination form you previously submitted. However, you will need to mail in additional background materials.


NOMINEE NAME
Please provide the nominee’s name and contact information. Provide the nominee’s name and, title exactly as it should appear on an award trophy and program materials. Please consider hyphenation, punctuation marks and capitalization.

Name
Title
Company
Email
Phone

INFORMATION ABOUT THE NOMINEE

1. Provide a brief career background for the nominee.
2. Explain how the individual demonstrates innovative qualities/characteristics.
3. Describe the individuals innovative accomplishments
4. Describe how the nominee's innovative accomplishments have contributed to the overall success of his/her company and industry.
5. Provide any other relevant information that the Selection Committee should consider. Please keep your comments brief.

REFERENCES

Provide at least two references from clients, peers, or colleagues attesting to the individual’s innovative qualities. Include title, company and contact information for each reference.

COMPANY LOGO
 Please email a high resolution photo of the nominee's company logo to Tammie Gonzalez at tlgonzalez@stoel.com (300-dpi JPEG, or eps format). If named a finalist and/or winner, the logo will be published in the Awards Banquet program, on media materials and the Idaho Innovation's Website

COMPANY INFORMATION
Please provide the official name, address, phone number, and Web address for the nominee's company

Name
Street Address
City
State
ZIP Code
Phone
Web Site

Trophy Representative
Schedule permitting, will the nominee attend the Awards Banquet to receive the trophy if he/she is named a finalist or winner? (Select one.)

Yes
No
If no, please provide the individual’s name and information for who will be attending in his/her place.

Name
Title
Phone
Email

ADDITIONAL MATERIALS

Permission to Use Materials
If this nominee is selected as a finalist or winner, Stoel Rives LLP has our permission to use our company logo in program materials and on the Idaho Innovation Awards web site. We also grant permission to Stoel Rives to use our company logo in materials distributed to media representatives.

Name
Title

You are invited to submit additional background materials to help the Selection Committee learn more about the nominee. Examples of items you may wish to include is information about other recognitions the nominee has received, and news articles or columns that reference the nominee.

Please email these documents directly to Tammie Gonzalez at tlgonzalez@stoel.com. Please call her at (208) 387-4244 if you have any problems.

How did you learn about the Idaho Innovation Awards Program?
Newspaper ad
Idaho Business Review
Email from a selection committee member
Internet search
Radio
Friend/Colleague
Stoel Rives attorney
Editorial story in local newspaper
Other

Indemnification Clause
PLEASE DO NOT SUBMIT ANY CONFIDENTIAL OR PROPRIETARY INFORMATION. By checking this box, you agree that this entry does not contain, and that neither you nor the innovating entity on whose behalf you have submitted this entry (the "Innovating Entity") will submit to Stoel Rives LLP or to any of the selection committee members ("Selection Committee Members") or sponsors ("Sponsors") of the Idaho Innovation Awards Program (the "Innovation Awards Program"), any information or other materials that you or the Innovating Entity deem to be confidential or proprietary. You further acknowledge and agree that any information or other materials submitted by you or the Innovating Entity in connection with the Innovation Awards Program may be used or disclosed by Stoel Rives LLP and the Sponsors and Selection Committee Members in connection with the Innovation Awards Program without restriction. Finally, you and the Innovating Entity agree to indemnify Stoel Rives LLP and the Sponsors and Selection Committee Members from and against any claims, losses, damages, liabilities, settlements, attorneys' fees and any other expenses any of them may incur in connection with their use of any information or materials they receive from you or the Innovating Entity.

I Agree

 

This is the end of the entry form.

Before submitting your nomination, please click on the button below to review the entry as it will be given to the Selection Committee. If you would like to make changes, simply return to this page and scroll back to the portion of the entry form that you want to modify.